动脉插管造影CTA与普通CTA显影股前外侧穿支的比较研究

A comparative study of selective CT arteriography versus CT angiography on three-dimensional display of perforators in anterolateral thigh perforator flap

目的探讨动脉插管造影CTA活体显影股前外侧穿支皮瓣穿支血管的可行性。方法选取拟定切取股前外侧穿支皮瓣移植患者15例。实验组运用选择性动脉插管技术将导管置入旋股外侧动脉开口处,证实导管达到预定位置并固定可靠后将患者转移至CT室。经导管注入造影剂20 ml,同时手动触发CT扫描。选取普通CTA作为对照组。将两组获得的二维图像以CT-DICOM输入到Mimics17.0软件,收集两组旋股外侧动脉主干及其分支的解剖学参数。采用SPSS22.0统计软件对数据进行统计处理,P值≤0.05认为差异有统计学意义。结果本组15例患者中,1例患者导管脱落至股深动脉,予以排除。其余14例患者中,旋股外侧动脉起源于股动脉3例(占21.43%),起源于股深动脉11例(占78.57%)。实验组旋股外侧动脉及其分支内径大于对照组。实验组升支、横支及降支长度均大于对照组,升支、横支及降支的末端最小内径均小于对照组。实验组显影穿支数目多于对照组。结论动脉插管造影CTA可清楚的显示旋股外侧动脉分支及其穿支,效果优于普通CTA。

Objective To explore the feasibility of selective lateral circumflex femoral artery（LCFA）CT arteriography for in vivo three-dimensional display of perforators in anterolateral thigh perforator（ALTP）flap. Methods We selected 15 patients who required the ALTP flap for repairing soft tissue defects of low extremities. In the experimental group, the method of selective LCFA catheterization was employed. The catheter was inserted into the ostia of LCFA in healthy side of the extremity and confirmed to be in a predetermined position and fixed, then the patient was transferred to the CT room. Transcatheter injecting contrast agent 20 ml, triggering CT scan at the same time. 10 minutes later, injecting contrast agent 100 ml via median cubital vein used as a control group. The two-dimensional images obtained by CT-DICOM format and output, Mimics software（version17.0） was used to visualize the perforators of LCFA. And the anatomical parameters of LCFA were observed and measured. All data analyses were performed using SPSS version 22.0 software. Results In 15 patients, one case was excluded because of artery catheter insertion into deep femoral artery. In the other 14 cases, the LCFA originated from the femoral artery in 3 cases（accounting for21.43%）, and from the deep femoral artery in 11 cases（accounting for 78.57%）. The diameter of the LCFA and its branches in the experimental group was larger than those in the control group. The length of the ascending, transverse and descending branches in the experimental group were longer than those of the control group. The smallest inner diameter of the ascending, transverse and descending branches in the experimental group were smaller than those of the control group. The number of perforators in the experimental group were more than the control group. Conclusion Selective CT arteriography of the LCFA can display the LCFA and its perforators clearly an obviously superior effect over non-selective CT angiography